Skills Checklist - Neonatal ICU - Origin Travel Nurses

Skills Checklist - Neonatal ICU

Name
First Last
Phone
Email

CARE OF PATIENTS WITH*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Aortic/Pulmonary Valve Stenosis
Atrial/Ventricular Septal Defects
Bradycardia
Coarctation of the Aorta
Congenitial Heart Disease
DIC
Hemodynamic Instability
Hypoplastic Left Heart System
Hypovolemic Shock
Patent Ductus Arteriosus
Post Cardiac Surgery
Tetralogy of Fallot
Transient Tachypnea
Transposition of the Great Arteries
Apnea
Bronchopulmonary Dysplasia (BPD)
Diaphragmatic Hernia
Meconium Aspiration Syndrome (MAS)
Pneumothorax
PPHN/PFC
Respiratory Distress Syndrome (RDS)
Respiratory Syncytial Virus (RSV)
Tracheostomy - fresh
Anencephaly
Cerebral Palsy
Hydrocephalus
Intraventricular Hemorrhage (IVH)
Meningitis
Periventricular Leukomalacia (PVL)
Seizures
Spina Bifida
Anal Atresia
Cleft Lip/Palate
Cystic Kidney Disease
Esophageal Atresia
Fetal Hydronephrosis
Gastroschisis/Omphalocele
IDM Hyperglycemia
IDM Hypoglycemia
Inguinal Hernia
Intestinal Obstruction
Jaundice/Hyperbilirubinemia
Necrotizing Enterocolitis (NEC)
Post Abdominal Surgery
Pyloric Stenosis
Tracheoesphogeal Fistula (TEF)
Birth Injuries
Congenital Hip Dislocation
Drug Addiction/Exposure
Fetal Alcohol Syndrome
HIV Positive Mother
HBsAg Positive Mother
Retinopathy of Prematurity (ROP)
Sepsis
Brain Death/Organ Procurement

MEDICATION ADMINISTRATION*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Aminophylline/Caffeine
Anticoagulants
Anticonvulsant Medications
Dobutamine (Dobutrex)
Dopamine (Intropin)
Epinephrine
Eye Prophylaxis
Immunizations
Insulin Drip
NaHCO3
Prostaglandin
Respigam/Synagis Prophylaxis
Steroids
Vitamin K
Pain Medications
IM Meds
IV drips
IV push
Eye Instillations
Dosage calculations for neonates

PROCEDURES/SKILLS - AIRWAY MANAGEMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Bulb Syringe
CPAP (nasal prongs)
PROCEDURES/SKILLS - AIRWAY MANAGEMENT (ENDOTRACHEAL TUBE)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
assist with insertion
stabilization of ETT
extubation
PROCEDURES/SKILLS - AIRWAY MANAGEMENT (SUCTIONING)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
ETT
Nasal
Oral
Tracheostomy
Cardiac Resuscitation
Chest Physiotherapy

PROCEDURES/SKILLS - CHEST TUBE & DRAINAGE SYSTEM*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Set up
Assist with insertion
Care & maintenance
Troubleshooting
Removal
Continuous Bladder Irrigation
EKG Intrepretation
Exchange Transfusion
Extracorporeal Membrane Oxygenation

PROCEDURES/SKILLS - HEMODYNAMIC MONITORING, NON-INVASIVE*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Auscultation
Doppler
Automatic BP cuff
Palpation
Hemodynamic Monitoring - Invasive
PROCEDURES/SKILLS - FEEDINGS*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Breastfeeding - assist
Breastmilk handling/storage
Bottle
Continuous tube feeding
Gavage
Reflux precautions
PROCEDURES/SKILLS - FEEDINGS (PLACEMENT OF TUBES)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
orogastric tube
nasogastric tube
nasojejunal tube
PROCEDURES/SKILLS - FEEDINGS (ASSESSING FEEDING TOLERANCE)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Gastric Suctioning - Intermittent
Gastric Suctioning - Continuous
PROCEDURES/SKILLS - INTERPRETATION OF LAB RESULTS*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Blood gases
Bilirubin
CBC/Diff
Cultures
Maternal lab results
PROCEDURES/SKILLS - INTERPRETATION OF LAB RESULTS (URINE TEST & INTERPRET)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Glucose
Labstix
pH
Specific Gravity
Occult Blood
Intracranial Pressure Monitoring
PROCEDURES/SKILLS - IV'S*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Starting IV
Site & Patency Assessment
Administration Blood/Blood Products

PROCEDURES/SKILLS - IV'S (MAINTENANCE/DISCONTINUATION OF)*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Broviac
Hickman
Heparin/Saline Lock
Percutaneous Arterial Line
Peripheral IV
PICC
Umbilical Arterial Catheter
Umbilical Venous Catheter
Hyperalimenation
Lumbar Puncture (assist with)
Nitric Oxide Therapy
Orthopedic Devices - casts, splints, etc

PROCEDURES/SKILLS - OXYGEN THERAPY ADMINISTRATION*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Bag & mask
ET tube
Oxyhood.
Nasal CPAP
Nebulizer
Trach Collar
PROCEDURES/SKILLS - SKIN*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Skin breakdown prevention
Wound healing
PROCEDURES/SKILLS - SKIN (COLOR CHANGE)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
mottling
petechiae
cyanosis
jaundice
PROCEDURES/SKILLS - SPECIMEN COLLECTION (BLOOD)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
arterial stick
heel stick
peripheral
Umbilical
PROCEDURES/SKILLS - SPECIMEN COLLECTION (CULTURES)*
Rarely Some Experience Proficient Trainer / Preceptor N/A
blood
wound
sputum
stool testing
PROCEDURES/SKILLS - TEMPERATURE*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Rectal
Skin
Axillary
Transillumination
PROCEDURES/SKILLS - WOUND/OSTOMY CARE*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Colostomy care/bag change
Ileostomy care/bag change
Irrigations
Sterile Dressing changes
Surgical wounds with drains
EQUIPMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Cardiac Monitor
Centrifuge
Defibrillator
Glucometer
O2 Analyzer
Oxygen Flow Meter
Oxyhood -
INFUSION PUMP BRAND #1
INFUSION PUMP BRAND #2
INFUSION PUMP BRAND #3
EQUIPMENT - INFUSION PUMPS EXPERTISE
Rarely Some Experience Proficient Trainer / Preceptor N/A
BRAND #1
BRAND #2
BRAND #3
EQUIPMENT - PHOTOTHERAPY EQUIPMENT*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Bili blanket
Bili lights
Bili meter
Computer Charting Systems
Positioning Devices
Pulse Oximeter
Oxyhood
EQUIPMENT - THERMOREGULATION*
Rarely Some Experience Proficient Trainer / Preceptor N/A
Isolette with Humidity
Radiant Warmer
Warming Lights
Transport Incubator
EQUIPMENT - VENTILATOR*
Rarely Some Experience Proficient Trainer / Preceptor N/A
CPAP/PEEP
High frequency jet
IMV
Transport
Oscillating
Home Ventilator

ASSESSMENT/OTHER*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Level II Nursery
Level III Nursery
Abdominal Girth Measurement
Admission of patients to unit
APGAR Scoring
Assess Breath Sounds
Assess Heart Sounds
Ballard Score
Bereavement support
Breastfeeding Teaching
Care Planning
Charge Nurse responsibilities
Circulation Checks
Computerized Charting
Developmental Intervention/Assessment
Dubowitz Score
Fontanel Assessment
Head circumference measurement
Isolation Procedures
Neurological Assessments
Pain Assessment
Pain Management
Parent Teaching of Normal Infant
Patient Teaching
ROM exercises
Sedation
Use of Restraints
Vital Signs

Do you speak any languages other than English?*
- No
If yes, enter languages above, separated by commas.

Age Group Experience*

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Newborn (birth - 30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School Age (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39-64 years)
Older Adults (64+ years)

Confirmation*
- I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education.
Signature
Date
MM slash DD slash YYYY

Skills Checklist – Neonatal ICU

Skills Checklist - Neonatal ICU

Origin Travel Nurses has earned the Joint Commission's Gold Seal of Approval

© 2023 Origin Travel Nurses. All Rights Reserved.

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Breastfeeding - assist
Breastmilk handling/storage
Bottle
Continuous tube feeding
Gavage
Reflux precautions

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Blood gases
Bilirubin
CBC/Diff
Cultures
Maternal lab results

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Glucose
Labstix
pH
Specific Gravity
Occult Blood
Intracranial Pressure Monitoring

	Rarely	Some Experience	Proficient	Trainer / Preceptor	N/A
Bag & mask
ET tube
Oxyhood.
Nasal CPAP
Nebulizer
Trach Collar